Wednesday, July 12, 2017

Repeal and repine

Updated early afternoon.

Drawing by Daryl Cagle via Juven Jacob.

Last week McConnell was in Kentucky telling the troops he might fail to put that health bill past his whole caucus—
“I’m in the position of a guy with a Rubik’s cube – trying to twist the dial in such a way to get at least 50 members of my conference who can agree to a version of repealing and replacing Obamacare,” McConnell told Kentucky voters at a town hall-style event on Thursday, according to NBC. “That is a very timely subject that I’m grappling with as we speak.”...
“If my side is unable to agree on an adequate replacement, then some kind of action with regard to the private health insurance market must occur,” McConnell told constituents at a Rotary Club lunch on Thursday, according to the Associated Press.
“No action is not an alternative,” he added. “We’ve got the insurance markets imploding all over the country, including in this state.”
—which sounded to me like he'd already failed. And what he was offering as the next step, stabilizing "the insurance markets", sounded a lot like doing some of the things that need to be done to repair the ACA, to clean up some of the damage from Republican sabotage that has caused premiums in the individual marketplace to go up for the government that subsidizes them, and for those buyers who are too well off to receive subsidies. With no tax cuts, but no Medicaid devastation either. For which he would certainly be able to assemble a bipartisan majority in the Senate, even though he'd lose a serious number of Republicans.

It also sounded that way to Juliet Eilperin and Amy Goldstein at the Washington Post, and, as they noticed:
Senate Minority Leader Charles E. Schumer (D-N.Y.) on Thursday called McConnell’s statement “encouraging” and said his caucus is “eager to work with Republicans to stabilize the markets and improve the law. At the top of the list should be ensuring cost-sharing payments are permanent, which will protect health care for millions.”
It sounded like movement toward what I've always thought should happen, a wide realization that the ACA can't be taken away "root and branch" and that most voters would end up preferring legislators to get to work on making it work better, and that the needed fix is not that heavy a lift. (Not to mention some of the donors, like hospital companies, if not insurers themselves, which seem not to appreciate huge expansion of business opportunities if they can't have monopolies.)

Also, you know, HHS secretary Tom Price and his department can lie all they want, but it's getting harder and harder to convince anybody that Obamacare is "imploding":\

And then there was this other, subtle thought, from Carl Hulse at The Times, suggesting that McConnell might be the sort of person who would be willing to do some kind of right thing if he had to, as long as he could figure out a way to do it that would allow his caucus to foam sufficiently at the mouth and not acknowledge defeat.

Mitch McConnell excels at devising crafty ways for Senate Republicans to avoid paying a high price on politically explosive issues.
Take, for instance, his ingenious 2011 plan to clear the way for increases in the federal debt limit without Republican fingerprints. The McConnell maneuver turned the always-contentious process on its head and allowed Republicans to register their opposition to the increases while simultaneously permitting the necessary rise in the debt limit to avoid an economic meltdown. Even critics tipped their hats.
Since he had indeed said the stabilization of the marketplaces was necessary, that it "must occur", I was starting to think this is really going to happen.

Now McConnell and his minions are back in the capital and it's clear that that moment has not arrived yet. He's offering yet another repeal-'n'-replace bill tomorrow, we learn from Thomas Kaplan and Robert Pear at The Times, to be voted on sometime next week, so that my Rosy Scenario won't be able to show up until after that, if ever.

There's something awfully funky about the new bill, though, as far as I can see from that report:

Senate Republicans are also likely to keep a pair of taxes imposed by the Affordable Care Act on people with high incomes. The law increased the payroll tax rate for many high-income taxpayers and imposed a tax on their investment income. Both taxes would be eliminated by the repeal bill passed by the House in May and by the original version of Mr. McConnell’s bill.
Keeping those taxes would undercut a major argument against the bill by Democrats, who have branded it as a tax cut for the rich disguised as a health bill.
But the largest changes to the health care system are likely to remain in the bill. About two-thirds of the increase in the projected number of uninsured Americans would result from deep cuts in expected Medicaid spending, the budget office said. The bill would impose caps on Medicaid spending and would roll back the expansion of the program under the Affordable Care Act.
The tax provisions up there would reduce the size of the GOP-proposed tax cut by something like $275 billion over ten years, maybe 40% of the total. But the enormous Medicaid cuts are still going on? What's up with that? Are they setting it up to present this as a deficit-reduction bill? Or is it just a grab bag of things that will make different constituencies in the Senate caucus happy (cutting the tax cut for the "populists" and slashing Medicaid for the "conservatives") with no thought as to how they might fit together? Or pure smokescreen while my optimistic idea is taking shape? Or is The Times screwing the story up?

I guess we'll find out soon.

Update: The uncut tax money is supposed to go to increased tax subsidies for Obamacare premiums and expanded stability fund for insurers, according to an article in The Hill. I imagine the people who will benefit most from the former are those freelance workers with pretty good incomes who really have been fucked over by this year's premium hikes (for which they don't get subsidies under present law). In this way the GOP is trying to co-opt the middle class into their evil plans, giving them help they definitely deserve, but with money stolen from Medicaid patients.

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